GW1-2022-01083_Well Construction - GW1_20220107

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V!!ELL ON9TR[JGTION RhCOR�IG1Ma1l
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I.WallContreelor ldfitpmafion:
Ronald G. Cannaady
Wolf Contmoior Name R
n. .
NC wet►cmnroataa cmtltlmtion.Nwl*a
Cannady WOWS Well CEO ng, Inc. IAL
company Ntttnt Cj �' -LIf 41i rn a•t!., s� O d
2.W011 Consiruellcn Permit n: 0005.3 Inc
List afheWleabte,tuff eonsinnrlva permits(t.e,file,Cvyt*;Slak.t'orfattee;elr,j IL 0.
3.Well Use Obeek well utie)s
star Supply W-eill i
Agricultural �M tlAtiblle �� it, /a f!. a/'' la. !1 .S UG firf '
0001haimai(Hoofing/Cooling Supply} 1dantial Water Supply(aln*) n. le
lndustriaUCommttrciol DResidenfial Wolof Supply(shared)
IL R
Irri 1
Non-Watersupply e11t n. n• off,;, c�tn -.00 Q
cmitorin Rax1v'.. , 0. L
n ee on well:
AqulfariEechttrge -------'�OrauttitEvrnter-Ramediat(an�� --- - --
Aquifer Storage and Recovery 09011nity Borrior IMBAC r
Aquifer Tat $totmtvoter Drainage
Luperimontoi Technology DBubsida tee Canirui'
Ocothermal(Closed Loop) near
Ciaoth I HoWin in Ratssm lain under k21 R s n.
4,Date well(,)Completed: /' Well iD1!
61 at Loentlon. r-
'Aiw- 5 n. to p
acuity/AuwnarNamo 11 Facility ION(irappilrolc) oft. n.
rQeta
Physical Addmic City,Ad Zip n. tt. < + any t
Cuunty fences Idmigtion No.(PIN)
6b.Latitude and tongoude in degm witninutestimmu s or dedrtml dew: ' ^
lihvoit na1J,one itnllang Is sumolont) _
S ' ..3.a 23 N .�.? .,,r 4.S�I.�:..L —W 7C2.Crrttliratloa: ;'.R ii �17
'�'rrnt�t:�c al
G.1c(nre)the well(g) rmanent or OTemporary Isitsta,c or cttt tv ceonta<4ar tfitc ,
d}tlgntng rh/r fit,f Rat abp cerrif}•that Ike trtfip)uvs prem)coullmeted is accmdanca
7,io this a mpotr to an Wiling welir [3vo or utth IPA NCAC .0t00 oP t$4 NCAC 02C.0200 Waft t onrtrmwal 5iandardt and that a
If this 1s a repair.Jiff out kaoum milt rOnHrt com JWbrnatfoa and e�lafn the naltire of the rM of this rmnl has berm ptmVdrd to the upH oerier.
jvlmlr ander III/moarst,section or or,the bock grthtr larm. _ .filte_dlt rrttn or 1polticnal Drell t3ctstls.___
B.For Gooprob OFfr or Closed-Loop Ceothernml Wd le heft the same You may use dw buck or this pap'to pprovide additionn wcii a'-daaUs or wall
construction,only I OW-1 is needed, indicate TOTAL.NUMBER of wells eonstvuetion details. You may also anach additional pages if neaeaeary.
drilled:
9.Total well depth below land tutfiaeo: ,1 .,, „it.) lida. Vor�t Submit this Rsrm within 30 days of completion of well
re pop a/tfpfo ntr)1•e lfrr all depiha(/diftmat farampt6 3Q14N1 ,&w 201thn construction to the flowing:
10,Slant:Water level Wow top of asln$t,,, (W D1vRtan of Watts Rinurcesh information Proming Uait,
fltmter Inv/Is abuse caahip,are.4" 1617 Mall 8enloe Center,Raleigh,ItiC 370%1611
11.Borehole diameter: -l�' (in.) 24b,fat jala*g 1Va11st in addition to dead %the form to the address in 24a
Rotary above,stm submit one copy of this fbam within 30 days or completion or well
p,o.Wallet,t ro
IL well ottatrcLbltary,cable,,Jl,uca push,.eta.)motheth construction tot ibllowing:
Divides of Water Resonmes,Vadet'grottdd lttlafto tJtsatrot Program.
FOR WATER SUPPLY WELLS ONLYs 1636 Melt liervlee Center,lietetgh.NC 276"4636
13a.view(`pin) mow or test• R tot:. Sending
In addition to shad the farm to
"the address(=) above, a submit bao copy of-this !brat within 30 days of
13b.Disinfection type: _✓ Amount-. 'tov PPS � completion of wail construction to ilia county hmdth department of the county
where constructed,
Form ow-1 Norris Carolina Department orEnvironro"m Quality-Division er water Rasourm Rcvisvvt 2-12.2016